TITLE:
The efficacy of empiric arterial embolization for treating severe hemoptysis
AUTHORS:
Peter I. Kalmar, Peter Schedlbauer, Martin Wehrschütz, Otto C. Dörfler, Hannes A. Deutschmann, Freyja-Maria Smolle-Jüttner, Rupert H. Portugaller
KEYWORDS:
Empiric Bronchial Arterial Embolization
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.3 No.2,
May
28,
2013
ABSTRACT: Aim:
Purpose of the study was to investigate the efficacy of empiric arterial
embolization in order to achieve hemostasis in patients with massive hemoptysis.
Materials and Methods: A retrospective review of histories and interventional
studies of 56 patients (40 male, 16 female, median age 57 years; range, 16 - 83
years) referred for endovascular treatment of massive hemoptysis over a period
of 17 years. Arteries supposed to supply the bleeding bronchoalveolar sections
were embolized with particles in all cases. Digital subtraction
angiographical (DSA) studies were analyzed with respect to the morphology of
the embolized arteries. Arteries were termed pathologic when they were either
hypertrophic or supplied hypervascular lung sections as well as actively
bleeding branches. Empiric embolization was defined as endovascular occlusion
of arteries without visible contrast-material extravasation on DSA studies.
Results: Continuing hemoptysis was encountered in one (25%) of 4 patients
with active contrast extravasation and in 11 (21%)
of 52 empirically embolized patients: Six (19%) of 32 patients with
pathologic arteries visible on aortography, 3 (18%) of 17 with pathologic
arteries visible by selective arteriography and 2 (67%) of 3 with no visible
pathologic arteries. From 6 patients (11%, 5 male, 1 female) who died within 30
days after embolization, 3 suffered from tuberculosis while 3 had malignant
tumors. Three had ongoing hemoptysis. One patient died of multiple organ
failure caused by post-interventional paraplegia and consecutive pneumonia.
Conclusion: In patients with hemoptysis, empirical
embolization is effective when pathologic bronchial arteries can be
identified by DSA.